Apolipoprotein A1 mimetics and uses thereof

ABSTRACT

The present invention provides peptidomimetics derived from Apolipoprotein A-I, which is useful for beneficially influencing lipid parameters and/or plasma cholesterol levels. The invention also provides pharmaceutical compositions and methods of treatment for elevated levels of plasma cholesterol.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.11/182,490, filed on Jul. 15, 2005, now U.S. Pat. No. 7,569,546; whichclaims the benefit of U.S. Provisional Application No. 60/588,722, filedon Jul. 16, 2004.

BACKGROUND OF THE INVENTION

Vascular diseases, such as cardiovascular, peripheral vascular andcerebral vascular, relating to or arising from lipid disorders, are aleading cause of death and disability in the developed world,particularly afflicting the elderly. Such diseases are a major cause ofdeath in the affluent countries including the United States, wherecardiovascular diseases are the cause of almost one million fatalitieseach year, more than one half of all deaths; almost 5 million personsafflicted with cardiovascular disease are hospitalized each year.

Arteriosclerosis refers to any group of diseases that are characterizedby thickening and loss of elasticity in arterial walls. Of thesediseases, atherosclerosis, the most common form of vascular disease, andcoronary artery diseases have the most significant impact. Normally, theinterior surface of the blood vessel is relatively smooth, allowing easypassage of the blood. In atherosclerosis, a common form of vasculardisease, deposits of yellowish plaques (atheromas) containingcholesterol, fatty material, calcium, and lipid-filled macrophages areformed within the intima and inner media of large and medium-sizedarteries. The plaque causes blockage of the blood vessel, facilitatingclotting and leading to insufficient blood supply to critical bodyorgans, which results in organ failures including heart attack, stroke,or kidney failure, and causing hypertension. Atherosclerosis underliesmost coronary artery disease.

The very earliest phase of the development of atherosclerotic lesions(the fatty streak) involves the entry of monocytes into thesubendothelial regions of the blood vessels. At the same time,low-density lipoprotein cholesterol (“LDL”) is retained in thesubendothelial regions and is oxidized, causing these monocytes, nowdifferentiated into macrophages, to uptake the oxidatively modified LDL,and stay localized. Such macrophages, or foam cells, increase in thesize and their subsequent death and secretion of fibrous elements fromthe vascular smooth muscle cells (“VSMC”) contribute to the formation ofthe plaque. Atherosclerosis can be considered a hyperproliferativedisease, wherein some of the normal VSMC in the artery wall becomeabnormally proliferative, and concurrently invading and spreading intothe inner vessel lining, blocking blood flow and making that vesselabnormally susceptible to being completely blocked by local bloodclotting. Such complete blockage may result in the death of the tissueserved by that artery.

While elevation of the LDL level is generally unwanted and is considereddetrimental to one's health, elevation of the HDL level is considered tobe protective against atherosclerosis. HDL cholesterol is often referredto as “good” cholesterol since the negative association between serumHDL concentration and coronary heart disease is at least as strong asthe positive association between low density lipoprotein (LDL) andcoronary heart disease. Apolipoproteins A-I (“Apo A-I”) and A2 are themajor apoprotein constituents of HDL, and have been considered to beanti-atherogenic due to their abilities to transport cholesterol fromarteries to the liver for catabolism and excretion. See Furchart, J. andAilhaud, G. (1992) Clin. Chem. 38:793-797.

Treatment of atherosclerosis includes management and reduction of theLDL cholesterol using drugs that are designed to inhibit cholesterolsynthesis such as HMG-CoA reductase inhibitors (statins), nicotinicacid, bile salt sequestrants, or fibric acid derivatives. Thesepharmaceutical agents, however, are not without significant sideeffects. Statins are known to show various degrees of myotoxicity(Rosenson, (2004) Am. J. Med. 116(6):408-16), and nicotinic acidcommonly induces vasodilatory effects. Fibrates are associated with anumber of adverse effects, including liver enzyme elevations,gastrointestinal side effects and rhabdomyolysis (Muscari et al. (2002)Cardiology 97(3):115-21).

Several Class A amphipathic helical peptide analogs of Apo A-I, which isderived from Apo A-I's eight tandem repeating 22-mer sequence, (Apo A-Imimetic peptides) have been shown to be effective againstatherosclerotic development. The C-terminal portion of Apo A-I (residues193 to 243) is thought to be actively involved in protein-lipidinteractions. Apo A-I mimetic peptides enhance the ability ofhigh-density lipoprotein (HDL) to protect low-density lipoprotein (LDL)from oxidation and remove seeding molecules from LDL. However, it is notclearly understood whether Apo A-I mimetic peptides protect LDL againstoxidation independent of HDL-mediated mechanisms. Such peptides aregenerally rapidly degraded in vivo.

It has been previously shown that L-4F, an 18 L-amino acid-containingmimetic peptide, and its D-amino acid analog D-4F, block LDL oxidationand LDL-induced monocyte chemotactic activity. Furthermore, D-4F hasbeen shown to be stable upon oral administration, resulting in almost80% reduction of atherosclerotic lesions in LDL receptor-null mice.Navab et al., (2002) Circulation 105:290-292. L-4F and D-4F have aprimary amino acid sequence Ac-D-W-F-K-A-F-Y-D-K-V-A-E-K-F-K-E-A-F-NH₂,(SEQ ID NO:1). The 18-mer has a potential to form a class A amphipathichelical structure (Segrest et al. (1974) FEBS Lett. 38:247-253). L-4Finhibits LDL and phospholipid oxidation through mechanisms independentof HDL-mediated processes.

Nevertheless, there is still a need for improved pharmaceutical agentsto treat, prevent, or alter the progress of vascular disorders having alipid based etiology, such as atherosclerosis, and generally todyslipidemia, elevated cholesterol or decreased HDL.

BRIEF SUMMARY OF THE INVENTION

The present invention provides peptidomimetics of peptides derived fromApolipoprotein A-I (“Apo A-I”), which are useful for beneficiallyinfluencing the plasma cholesterol levels and vascular diseases, such asthrough altering lipid parameters. In certain embodiments, thepeptidomimetic has a substantially similar three-dimensionalconformation as a peptide comprising a D-amino acid sequenceF-A-E-K-F-K-E-A-V-K-D-Y-F-A-K-F-W-D (SEQ ID NO:3). The compounds of thepresent invention can be advantageously prophylactically administered toa patient at risk of or showing the symptoms of vascular diseases oflipid etiology such as atherosclerosis, hypercholesterolemia,hyperlipidemia, PAD, CHD and cerebral vascular diseases.

The compounds of present invention are peptidomimetics, in particularamino acid polymers in retro-inverso configuration.

The invention includes the use of peptidomimetics disclosed herein asresearch tools, such as in determining the anti-atheroscleroticpotential of other compounds, investigating lipoprotein-receptorinteractions in animals and animal models, and elucidating themechanisms of lipid metabolism, including identifying animal models forlipid metabolism studies.

The invention also includes the use of the peptidomimetics disclosed inmedicine. In addition, the invention includes the use of thepeptidomimetics disclosed herein in the manufacture of a medicament fortreating a disease or condition disclosed herein.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 depicts the peptides and peptidomimetic derived from Apo A-I.

FIGS. 2A-D depict the elution profiles of ¹⁴C-labeled phospholipid andprotein or peptide.

FIGS. 3A and B depict the ability of lipid bound peptides and Apo A-I topromote SR-BI-dependent cholesterol efflux.

FIGS. 4A and B depict the ability of lipid-free peptides and Apo A-I topromote ABCA1-dependent cholesterol efflux.

FIG. 5 shows that the peptidomimetics L-4F, D-4F and Rev D-4-F inhibitlipid peroxidation caused by endothelial cells.

FIG. 6 shows that the peptidomimetics L-4F, D-4F and Rev D-4-F inhibitlipid peroxidation caused by copper sulfate.

FIG. 7 shows that the peptidomimetics L-4F, D-4F and Rev D-4-F inhibitMCP-1 mRNA expression in endothelial cells.

DETAILED DESCRIPTION OF THE INVENTION I. Overview

There is a strong correlation between vascular ailments and abnormallipid parameters, such as elevated levels of cholesterol, especially LDLcholesterol in the blood and in the cardiovascular system in general anddecreased HDL. Beneficially altering the lipid parameters so as tocontrol the amounts of cholesterol within the circulating blood as wellas in local foci is considered to be effective in reducing theoccurrence of atherosclerosis and subsequent morbidity.

The present invention provides peptidomimetics of Apolipoprotein A-I,which is useful for altering the lipid parameters so as to beneficiallyinfluence the plasma cholesterol levels. The present invention isfurther generally directed to methods and compositions for treatment ofabnormally elevated cholesterol levels in the cardiovascular system.

II. Definitions

The term “amino acid residue” is known in the art. In general theabbreviations used herein for designating the amino acids and theprotective groups are based on recommendations of the IUPAC-IUBCommission on Biochemical Nomenclature (see Biochemistry (1972)11:1726-1732). In certain embodiments, the amino acids used in theapplication of this invention are those naturally occurring amino acidsfound in proteins, or the naturally occurring anabolic or catabolicproducts of such amino acids which contain amino and carboxyl groups.Particularly suitable amino acid side chains include side chainsselected from those of the following amino acids: glycine, alanine,valine, cysteine, leucine, isoleucine, serine, threonine, methionine,glutamic acid, aspartic acid, glutamine, asparagine, lysine, arginine,proline, histidine, phenylalanine, tyrosine, and tryptophan.

The term “amino acid residue” further includes analogs, derivatives andcongeners of any specific amino acid referred to herein, as well asC-terminal or N-terminal protected amino acid derivatives (e.g. modifiedwith an N-terminal or C-terminal protecting group). For example, thepresent invention contemplates the use of amino acid analogs wherein aside chain is lengthened or shortened while still providing a carboxyl,amino or other reactive precursor functional group for cyclization, aswell as amino acid analogs having variant side chains with appropriatefunctional groups). For instance, the subject compound can include anamino acid analog such as, for example, cyanoalanine, canavanine,djenkolic acid, norleucine, 3-phosphoserine, homoserine,dihydroxy-phenylalanine, 5-hydroxytryptophan, 1-methylhistidine,3-methylhistidine, diaminopimelic acid, ornithine, or diaminobutyricacid. Other naturally occurring amino acid metabolites or precursorshaving side chains which are suitable herein will be recognized by thoseskilled in the art and are included in the scope of the presentinvention.

As used herein, the terms “agent” and “compound” include both proteinand non-protein moieties. An agent may be a small organic molecule, apolypeptide, a protein, a peptide complex, a peptidomimetic, anon-peptidyl agent, or a polynucleotide.

As used herein, “ameliorates” means alleviate, lessen, or decrease theextent of a symptom or decrease the number of occurrences of episodes ofa disease manifestation.

“Apoproteins” are specialized proteins in the outer shell oflipoproteins. While different apoproteins are found in varying amountsin the lipoproteins, all play a crucial role in lipoprotein metabolism.Some apoproteins on lipoprotein particle interact with specific cellsurface receptors, while others activate or deactivate enzymes involvedin lipid metabolism. Ten principal apoproteins have been isolated andcharacterized, which are synthesized and secreted by the liver and theintestine. Certain lipoproteins comprise certain particle class. Forexample, Apolipoprotein (“Apo”) B-100 is associated with VLDL, IDL, andLDL, whereas Apo A is associated with HDL. Apo B-100 helps removecholesterol from the blood and Apo A helps HDL remove cholesterol fromtissues.

Apo A-I is the major HDL apoprotein and is required for normalproduction of HDL. The precursor of most plasma HDL is a discoidalparticle containing Apo A-I and phospholipids called pre-β1 HDL.Discoidal pre-β1 HDL can acquire free (unesterified) cholesterol fromthe cell membranes of tissues, such as arterial wall macrophages byinteracting with the class B, type I scavenger receptor to which the ApoA-I of HDL docks so the free cholesterol to or from the HDL particle.After free cholesterol is acquired by pre-β1 HDL, it is esterified,nonpolarized and moves into the core of the HDL.

It is believed that “atherosclerosis” begins with an injury to the innerwall of the artery (endothelium or endothelial cells). Once the innerwall is damaged, a combination of biological processes can lead to theaccumulation of the plaque. In response to the injury, macrophagesaccumulate at the site and migrate beneath the inner layer. Themacrophages then begin to absorb fatty substances from the blood andbecome foam cells. An accumulation of foam cells and other substances,such as proliferating smooth muscle cells, contribute to the formationof plaque and eventually forms bulges in the artery wall. Over time, asthe bulges continue to absorb fatty substances, plaque accumulationsnarrow the vessel lumen and occlude the blood flow. Further, plaqueaccumulation may cause blood vessel walls to harden and lose theirelasticity, which can increase resistance to blood flow and raise bloodpressure. As a result, vascular diseases are considered a progressiveillness with symptoms often not evident until people are middle aged orolder.

The accumulating plaque causes blockage of the blood vessel,facilitating clotting and leading to insufficient blood supply tocritical body organs, which results in decreased supply of oxygen andnutrients, which results in organ failures including heart attack,stroke, or kidney failure, and causing hypertension. Whenatherosclerosis occurs in the coronary arteries (coronary artery disease(CAD) or coronary heart disease (CHD)) the condition may result inoxygen starvation to the heart leading to conditions such as cardiacischemia, angina, myocardial infarction, arrhythmias and eventually in aheart attack, a major cause of morbidity and mortality in recent years.When atherosclerosis occurs in the peripheral arteries (peripheralartery disease (PAD), the condition may result in oxygen starvation tothe legs muscles leading to decreased mobility and eventually to loss ofmobility.

The term “ED₅₀” means the dose of a drug which produces 50% of itsmaximum response or effect.

An “effective amount” of, e.g., a peptidomimetic, with respect to thesubject method of treatment, refers to an amount of the peptidomimeticin a preparation which, when applied as part of a desired dosage regimeninhibits or brings about, e.g., prevents or produces change in the rateor number of atherosclerotic lesion formation according to clinicallyacceptable standards for the disorder to be treated or the effectdesired.

The term “healthcare providers” refers to individuals or organizationsthat provide healthcare services to a person, community, etc. Examplesof “healthcare providers” include doctors, hospitals, continuing careretirement communities, skilled nursing facilities, subacute carefacilities, clinics, multispecialty clinics, freestanding ambulatorycenters, home health agencies, and HMO's.

As used herein, “inhibits” means that the amount is reduced as comparedwith the amount that would occur in a control sample. In a preferredembodiment, inhibits means that the amount is reduced by more than 50%,even more preferably by more than 75% or even 100%.

As used herein, “instruction material” means a document or recordedmedia including a written or audible instruction for the use of apharmaceutical composition. An instruction material includes a label ona bottle, a paper inserted a box, printing on the box or carton,instructions provided by a website at an address given in any of theselocations, etc.

The term “LD₅₀” means the dose of a drug which is lethal in 50% of testsubjects.

“Lipids” are fatty substances that are insoluble in water and includefats, oils, waxes, and related compounds. They may be either made in theblood (endogenous) or ingested in the diet (exogenous). Lipids areessential for normal body function and whether produced from anexogenous or endogenous source, they must be transported and thenreleased for use by the cells. The production, transportation andrelease of lipids for use by the cells is referred to as lipidmetabolism. While there are several classes of lipids, two major classesare cholesterol and triglycerides. Cholesterol may be ingested in thediet and manufactured by the cells of most organs and tissues in thebody, primarily in the liver. Cholesterol can be found in its free formor, more often, combined with fatty acids as what is called cholesterolesters.

Due to their insolubility in water, lipids, such as cholesterol, cannotbe transported in the blood until they are packaged into specialmolecules called lipoproteins. Thus, cholesterol circulates in thebloodstream as particles associated with lipoproteins.

“Lipoproteins” are spherical compounds that are structured so thatwater-insoluble lipids are contained in a partially water-soluble shell.Depending on the type of lipoprotein, the contents include varyingamounts of free and esterified cholesterol, triglycerides andapoproteins or apolipoproteins. There are five major types oflipoproteins, which differ in function and in their lipid and apoproteincontent and are classified according to increasing density: (i)chylomicrons and chylomicron remnants, (ii) very low densitylipoproteins (“VLDL”), (iii) intermediate-density lipoproteins (“IDL”),(iv) low-density lipoproteins (“LDL”), and (v) high-density lipoproteins(“HDL”). Cholesterol circulates in the bloodstream as particlesassociated with lipoproteins.

LDL becomes atherogenic when modified by oxidation, a required step forLDL uptake by the scavenger receptors of macrophages in plaque build-up,which leads to the formation of foam cells. Class A amphipathic domainof Apo A-I in mimetic peptides is responsible for its lipid associatingproperty. Apo A-I mimetic peptides of the invention generally alter theLDL lipid parameter by removing phospholipid seeding molecules on LDL,rendering the LDL molecules resistant to oxidation by endothelial cells.Further, it is believed that Apo A-I mimetic peptides of the inventionoften alter the lipid parameter HDL by converting pro-inflammatory HDLto anti-inflammatory HDL by stripping oxidized cholesterol from the HDL.

The exogenous pathway for lipid metabolism describes the process bywhich dietary ingested triglycerides and cholesterol are transported bychylomicrons from the digestive tract to the bloodstream and, afterchylomicrons deliver triglycerides to the fat and muscle cells,chylomicron remnants return the remaining cholesterol to the liver forrecycling. Specifically, dietary fats enter the small intestine from thestomach and are broken down and absorbed into the lining into the liningof the small intestine where they are packaged into chylomicrons andenter the bloodstream. Once chylomicrons enter the bloodstream, most oftheir triglycerides are released by lipoprotein lipase, an enzyme foundin the capillary walls of fat and muscle cells. The fat cells and otherperipheral cells utilize the use or store most of the triglycerides.Chylomicron remnants then package the residual triglycerides and most ofthe dietary cholesterol and return to the liver where they are taken upby the liver cells via a specific receptor mechanism mediated byapoproteins and the chylomicron remnants are catabolized into theirconstituent parts. The liver uses the resulting cholesterol to form bileacids and VLDL.

The endogenous pathway for lipid metabolism describes the process bywhich internally synthesized cholesterol is produced, transported andreleased. While all cells may make cholesterol, seventy percent issynthesized in the liver thus, the discussion will focus on hepaticsynthesized cholesterol. Triglycerides synthesized in the liver combinewith cholesterol (either synthesized in the liver or delivered bychylomicron remnants and HDL particles) and lipoprotein to form VLDL,enter the bloodstream and are transported to peripheral cells such asfat and muscle cells. Lipoprotein lipase removes most of thetriglycerides, which are used for fuel and storage, from the VLDL. Afterreleasing the triglycerides for use by the cells, VLDL is transformedinto IDL, which is either cleared from the blood by the liver orconverted to LDL. LDL is cholesterol rich and delivers cholesterol tocells or is cleared from the blood. If there is excess cholesterol, itcan be taken up by cells in the blood vessel wall, leading toatherosclerosis. HDL, made in the liver and small intestine, acceptsexcess cholesterol from the cells and returns it to the liver forremoval from the body. HDL also returns cholesterol to the liverindirectly by transferring cholesterol to VLDL, IDL or LDL.

An improvement in “lipid parameters” includes one or more of a decreasein the propensity of lipoproteins to adhere to a blood vessel, adecrease in the amount of atherosclerotic plaque (even though plasma LDLand/or HDL concentrations have not significantly changed), a reductionin the oxidative potential of an HDL or LDL particle, a regression inatherosclerosis (e.g., as measured by carotid angiography or ultrasound)and a reduction in cardiac events.

A “peptidomimetic” includes any modified form of an amino acid chain,such as a phosphorylation, capping, fatty acid modification andincluding unnatural backbone and/or side chain structures. As describedbelow, a peptidomimetic comprises the structural continuum between anamino acid chain and a non-peptide small molecule. Peptidomimeticsgenerally retain a recognizable peptide-like polymer unit structure.Thus, a peptidomimetic may retain the function of binding to any targetmolecule that a natural peptide binds to.

The term “preventing” is art-recognized, and when used in relation to acondition, such as recurrence or onset of a disease such ashypercholesterolemia, is well understood in the art, and includesadministration of a composition which reduces the frequency of, ordelays the onset of, symptoms of a medical condition in a subjectrelative to a subject which does not receive the composition.

A “subject” or “patient” to be treated by the subject method can meaneither a human or non-human animal.

As used herein, “treating” means either slowing, stopping or reversingthe progression of the disorder. In a preferred embodiment, “treating”means reversing the progression to the point of eliminating thedisorder.

As used herein, the term “unwanted cholesterol” means low-densitylipoprotein (“LDL”) cholesterol and/or a mixture of LDL and high-densitylipoprotein (“HDL”) cholesterol having a ratio of HDL/LDL that isundesirable for one's health. The meaning of LDL and HDL is well knownin the art. In general, elevated levels of LDL cholesterol are notdesirable (above 180 mg/dl), and a certain amount of HDL cholesterol(above 35 mg/dl) is beneficial to the cardiovascular health. Inparticular, high concentrations of LDL (above 180 mg/dl) and lowconcentrations of HDL (below 35 mg/dl) have been shown to be importantcontributors to the development of atherosclerosis. Other diseases, suchas peripheral vascular disease, stroke, and hypercholesterolemia arealso negatively affected by adverse HDL/LDL ratios.“Hypercholesterolemia” is generally defined as having an elevated levelof total cholesterol above 200 mg/dl, especially with the LDL levelabove 160 mg/dl. It can be an autosomal dominant genetic disease(familial hypercholesterolemia). Hypercholesterolemia impairsvasodilation, leading to hypertension and impaired circulation.Therefore, controlling the levels of each type of the lipoproteins iseffective and necessary to maintain cardiovascular health.

The terms “amine” and “amino” are art-recognized and refer to bothunsubstituted and substituted amines, e.g., a moiety that can berepresented by the general formula:

wherein R₉, R₁₀ and R′₁₀ each independently represent a hydrogen, analkyl, an alkenyl, —(CH₂)_(m)—R₈, or R₉ and R₁₀ taken together with theN atom to which they are attached complete a heterocycle having from 4to 8 atoms in the ring structure; R₈ represents an aryl, a cycloalkyl, acycloalkenyl, a heterocycle or a polycycle; and m is zero or an integerin the range of 1 to 8. In preferred embodiments, only one of R₉ or R₁₀can be a carbonyl, e.g., R₉, R₁₀ and the nitrogen together do not forman imide. In still more preferred embodiments, the term ‘amine’ does notencompass amides, e.g., wherein one of R₉ and R₁₀ represents a carbonyl.In even more preferred embodiments, R₉ and R₁₀ (and optionally R′₁₀)each independently represent a hydrogen, an alkyl, an alkenyl, or—(CH₂)_(m)—R₈. Thus, the term “alkylamine” as used herein means an aminegroup, as defined above, having a substituted or unsubstituted alkylattached thereto, i.e., at least one of R₉ and R₁₀ is an alkyl group.

The term “amido” is art-recognized as an amino-substituted carbonyl andincludes a moiety that can be represented by the general formula:

wherein R₉, R₁₀ are as defined above. Preferred embodiments of the amidewill not include imides which may be unstable.

The phrase “protecting group” as used herein means temporarysubstituents which protect a potentially reactive functional group fromundesired chemical transformations. Examples of such protecting groupsinclude esters of carboxylic acids, silyl ethers of alcohols, andacetals and ketals of aldehydes and ketones, respectively. The field ofprotecting group chemistry has been reviewed (Greene, T. W.; Wuts, P. G.M. Protective Groups in Organic Synthesis, 2^(nd) ed.; Wiley: New York,1991).

III. Exemplary Embodiments

Compounds

Peptidomimetics are compounds based on, or derived from, peptides andproteins. The peptidomimetics of the present invention typically can beobtained by structural modification of one or more native amino acidresidues, e.g., using unnatural amino acids, conformational restraints,isosteric replacement, and the like. The subject peptidomimeticsconstitute the continuum of structural space between peptides andnon-peptide synthetic structures.

Such peptidomimetics can have such attributes as being non-hydrolyzable(e.g., increased stability against proteases or other physiologicalconditions which degrade the corresponding peptide copolymers),increased specificity and/or potency. For illustrative purposes, peptideanalogs of the present invention can be generated using, for example,benzodiazepines (e.g., see Freidinger et al. in “Peptides: Chemistry andBiology,” G. R. Marshall ed., ESCOM Publisher: Leiden, Netherlands,1988), substituted gamma lactam rings (Garvey et al. in “Peptides:Chemistry and Biology,” G. R. Marshall ed., ESCOM Publisher: Leiden,Netherlands, 1988, p 123), C-7 mimics (Huffman et al. in “Peptides:Chemistry and Biology,” G. R. Marshall ed., ESCOM Publisher: Leiden,Netherlands, 1988, p. 105), keto-methylene pseudopeptides (Ewenson etal. (1986) J. Med. Chem. 29:295; and Ewenson et al. in “Peptides:Structure and Function (Proceedings of the 9th American PeptideSymposium),” Pierce Chemical Co. Rockland, Ill., 1985), β-turn dipeptidecores (Nagai et al. (1985) Tetrahedron Lett. 26:647; and Sato et al.(1986) J. Chem. Soc. Perkin Trans. 1:1231), β-aminoalcohols (Gordon etal. (1985) Biochem. Biophys. Res. Commun. 126:419; and Dann et al.(1986) Biochem. Biophys. Res. Commun. 134:71), diaminoketones (Natarajanet al. (1984) Biochem. Biophys. Res. Commun. 124:141), andmethyleneamino-modified (Roark et al. in “Peptides: Chemistry andBiology,” G. R. Marshall ed., ESCOM Publisher: Leiden, Netherlands,1988, p134). Also, see generally, Session III: Analytic and syntheticmethods, in “Peptides: Chemistry and Biology,” G. R. Marshall ed., ESCOMPublisher: Leiden, Netherlands, 1988)

Numerous surrogates have been developed for the amide bond of peptides.Frequently exploited surrogates for the amide bond include the followinggroups (i) trans-olefins, (ii) fluoroalkene, (iii) methyleneamino, (iv)phosphonamides, and (v) sulfonamides.

EXAMPLES OF SURROGATES

Additionally, peptidomimetics based on more substantial modifications ofthe backbone of a peptide can be used. Peptidomimetics which fall inthis category include (i) retro-inverso analogs, and (ii) N-alkylglycine analogs (so-called peptoids).

EXAMPLES OF ANALOGS

Furthermore, the methods of combinatorial chemistry are being brought tobear on the development of peptidomimetic copolymers. For example, oneembodiment of a so-called “peptide morphing” strategy focuses on therandom generation of a library of peptide analogs that comprise a widerange of peptide bond substitutes.

In a preferred embodiment of the present invention, the peptidomimeticis a retro-inverso analog. Retro-inverso analogs can be made accordingto the methods known in the art, in a manner similar to synthesizingL-amino acid based peptides. More specifically, see methods such as thatdescribed by Sisto et al. in U.S. Pat. No. 4,522,752. The final product,or intermediates thereof, can be purified by HPLC or any other suitablechromatographic method.

In another illustrative embodiment, the peptidomimetic can be derived asa retro-enantio analog. Retro-enantio analogs such as this can besynthesized from commercially available D-amino acids (or analogsthereof) and standard solid- or solution-phase peptide-synthesistechniques.

In still another illustrative embodiment, trans-olefin derivatives canbe made. A trans-olefin analog of a peptide can be synthesized accordingto the method of Y. K. Shue et al. (1987) Tetrahedron Lett. 28:3225, andalso according to other methods known in the art. It will be appreciatedthat variations in the cited procedure, or other procedures available,may be necessary according to the nature of the reagent used.

It is further possible to couple the pseudodipeptides synthesized by theabove method to other pseudodipeptides, to make pseudopeptides withseveral olefinic functionalities in place of amide functionalities. Forexample, pseudodipeptides corresponding to certain di-peptide sequencescould be made and then coupled together by standard techniques to yieldan analog of the peptide which has alternating olefinic bonds betweenresidues.

Still another class of peptidomimetic derivatives includes phosphonatederivatives. The synthesis of such phosphonate derivatives can beadapted from known synthesis schemes. See, for example, Loots et al. in“Peptides: Chemistry and Biology,” (Escom Science Publishers, Leiden,1988, p. 118); Petrillo et al. in “Peptides: Structure and Function(Proceedings of the 9th American Peptide Symposium),” Pierce ChemicalCo. Rockland, Ill., 1985).

In other embodiments, the modification may be the introduction ofcarbohydrate or lipid moieties. Such modifications also change thesolubility of the peptides in various mediums so that they canadvantageously be prepared as a suitable pharmaceutical composition.Modifying lipid groups include farnesyl groups and myristoyl groups.Modifying carbohydrate groups include single sugars or oligosaccharidesof any naturally occurring and/or synthetic sugar and sugar alcohols,for example glucose, galactose, rhamnose, mannose, arabinose, and othersugars, and their respective alcohols.

The compounds of present invention comprise at least 15 amino acidresidues, and more preferably 18 amino acid residues.

In certain embodiments, the peptidomimetic of the present invention hasa substantially similar three-dimensional conformation as a peptidecomprising a D-amino acid sequence F-A-E-K-F-K-E-A-V-K-D-Y-F-A-K-F-W-D(SEQ ID NO:3). In particular embodiments, the peptide includes at leastone backbone linkage that is not an amide linkage in the amino tocarboxy direction, such as a retro-inverso peptide relative to anaturally-occurring peptide, or at least one backbone linkage that isnot an amide linkage.

In an exemplary embodiment, the peptidomimetic has at least 75%, atleast 80%, at least 85%, at least 90% or at least 95% identity to SEQ IDNO:3 or SEQ ID NO:2. Non-identical amino acid residues can be naturallyor non-naturally occurring. The term “percent identical” refers tosequence identity between two amino acid sequences or between twonucleotide sequences. Identity can each be determined by comparing aposition in each sequence which may be aligned for purposes ofcomparison. When an equivalent position in the compared sequences isoccupied by the same base or amino acid, then the molecules areidentical at that position; when the equivalent site occupied by thesame or a similar amino acid residue (e.g., similar in steric and/orelectronic nature), then the molecules can be referred to as homologous(similar) at that position. Expression as a percentage of homology,similarity, or identity refers to a function of the number of identicalor similar amino acids at positions shared by the compared sequences.Expression as a percentage of homology, similarity, or identity refersto a function of the number of identical or similar amino acids atpositions shared by the compared sequences. Various alignment algorithmsand/or programs may be used, including FASTA, BLAST, or ENTREZ. FASTAand BLAST are available as a part of the GCG sequence analysis package(University of Wisconsin, Madison, Wis.), and can be used with, e.g.,default settings. ENTREZ is available through the National Center forBiotechnology Information, National Library of Medicine, NationalInstitutes of Health, Bethesda, Md. In one embodiment, the percentidentity of two sequences can be determined by the GCG program with agap weight of 1, e.g., each amino acid gap is weighted as if it were asingle amino acid or nucleotide mismatch between the two sequences.

In another exemplary embodiment, which can overlap with the embodimentsdescribed above, the amino acids in the peptidomimetic of SEQ ID NO:3 orSEQ ID NO:2 are substituted with conservative amino acid residues. Theterm “conservative amino acid substitution” refers to the substitution(conceptually or otherwise) of an amino acid from one such group with adifferent amino acid from the same group. A functional way to definecommon properties between individual amino acids is to analyze thenormalized frequencies of amino acid changes between correspondingproteins of homologous organisms (Schulz, G. E. and R. H. Schirmer,Principles of Protein Structure, Springer-Verlag). According to suchanalyses, groups of amino acids may be defined where amino acids withina group exchange preferentially with each other, and therefore resembleeach other most in their impact on the overall protein structure(Schulz, G. E. and R. H. Schirmer, Principles of Protein Structure,Springer-Verlag). One example of a set of amino acid groups defined inthis manner include: (i) a charged group, consisting of Glu and Asp,Lys, Arg and His, (ii) a positively-charged group, consisting of Lys,Arg and His, (iii) a negatively-charged group, consisting of Glu andAsp, (iv) an aromatic group, consisting of Phe, Tyr and Trp, (v) anitrogen ring group, consisting of His and Trp, (vi) a large aliphaticnonpolar group, consisting of Val, Leu and Ile, (vii) a slightly-polargroup, consisting of Met and Cys, (viii) a small-residue group,consisting of Ser, Thr, Asp, Asn, Gly, Ala, Glu, Gln and Pro, (ix) analiphatic group consisting of Val, Leu, Ile, Met and Cys, and (x) asmall hydroxyl group consisting of Ser and Thr.

In a preferred embodiment, the peptidomimetic of the present inventionis a retro-inverso peptide of the D-amino acid sequence:

(SEQ ID NO: 3) F-A-E-K-F-K-E-A-V-K-D-Y-F-A-K-F-W-Dwherein each letter stands for the conventional one-letter amino acidcode, but of the D-amino acid.

In a more preferred embodiment, the peptidomimetic of the presentinvention is a retro-inverso peptide of the D-amino acid sequence:

(SEQ ID NO: 2) Ac-F-A-E-K-F-K-E-A-V-K-D-Y-F-A-K-F-W-D-NH₂ (I)wherein each letter stands for the conventional one-letter amino acidcode, but of the D-amino acid.

In other embodiments, the peptidomimetics of the present invention areanalogs of (I) wherein one or more D-amino acid residues are substitutedby other D-amino acids or other unnatural residues that, uponsubstitution, retain the spatial and ionic or nonionic character of theresidues that they substitute.

The peptidomimetics of the present invention, including theretro-inverso peptide of (I), may be modified so that the amino and/orcarboxy terminus is protected by a protecting group such as acetyl,CH₃—(CH2)_(n)—CO—, amide, Fmoc, t-butoxycarbonyl (t-BOC),9-fluoreneacetyl group, 1-fluorenecarboxylic group, 9-fluorenecarboxylicgroup, 9-fluorenone-1-carboxylic group, benzyloxycarbonyl, Xanthyl(Xan), Trityl (Trt), 4-methyltrityl (Mtt), 4-methoxytrityl (Mmt),4-methoxy-2,3,6-trimethyl-benzenesulphonyl (Mtr), Mesitylene-2-sulphonyl(Mts), 4,4-dimethoxybenzhydryl (Mbh), Tosyl (Tos), 2,2,5,7,8-pentamethylchroman-6-sulphonyl (Pmc), 4-methylbenzyl (MeBzl), 4-methoxybenzyl(MeOBzl), Benzyloxy (BzlO), Benzyl (Bzl), Benzoyl (Bz),3-nitro-2-pyridinesulphenyl (Npys),1-(4,4-dimethyl-2,6-dioxocyclohexylidene)ethyl (Dde), 2,6-dichlorobenzyl(2,6-DiCl-Bzl), 2-chlorobenzyloxycarbonyl (2-Cl-Z),2-bromobenzyloxycarbonyl (2-Br-Z), Benzyloxymethyl (Bom), cyclohexyloxy(cHxO), t-butoxymethyl (Bum), t-butoxy (tBuO), t-Butyl (tBu), andTrifluoroacetyl (TFA). The variable n is an integer from 0 to 12,typically 0 to 6 such as 0 to 4.

In certain embodiments, the peptidomimetics of the invention may furthercomprise modifications analogous to post-translational modifications.Such modifications include, but are not limited to, acetylation,carboxylation, glycosylation, phosphorylation, lipidation, andacylation. As a result, the modified peptidomimetics may containnon-amino acid elements, such as polyethylene glycols, lipids, poly- ormono-saccharide, and phosphates. Effects of such non-amino acid elementson the functionality of a peptidomimetic may be tested by methods suchas those described in the working examples.

Therapeutic Compositions

Another aspect of the present invention provides pharmaceuticalcompositions comprising a pharmaceutically effective amount of apeptidomimetic of the present invention and an acceptable carrier and/orexcipients. A pharmaceutically acceptable carrier includes any solvents,dispersion media, or coatings that are physiologically compatible thatpreferably does not interfere with or otherwise inhibit the activity ofthe peptidomimetic. Preferably, the carrier is suitable for intravenous,intramuscular, oral, intraperitoneal, transdermal, topical, orsubcutaneous administration. One exemplary pharmaceutically acceptablecarrier is physiological saline. Other pharmaceutically acceptablecarriers and their formulations are well-known and generally describedin, for example, Remington's Pharmaceutical Science (18^(th) Ed., ed.Gennaro, Mack Publishing Co., Easton, Pa., 1990). Variouspharmaceutically acceptable excipients are well-known in the art and canbe found in, for example, Handbook of Pharmaceutical Excipients (4^(th)ed., Ed. Rowe et al. Pharmaceutical Press, Washington, D.C.). Thecomposition can be formulated as a solution, microemulsion, liposome,capsule, tablet, or other suitable form. The active component may becoated in a material to protect it from inactivation by the environmentprior to reaching the target site of action.

In certain embodiments of the present invention, the pharmaceuticalcompositions are sustained release formulations. Peptidomimetics of thepresent invention may be admixed with biologically compatible polymersor matrices which control the release rate of the copolymers into theimmediate environment. Controlled or sustained release compositionsinclude formulation in lipophilic depots (e.g., fatty acids, waxes,oils). Also contemplated by the invention are particulate compositionscoated with polymers (e.g., poloxamers or poloxamines). Otherembodiments of the compositions of the invention incorporate particulateforms, protective coatings, protease inhibitors or permeation enhancersfor various routes of administration, including parenteral, pulmonary,nasal and oral. Acceptable carriers include carboxymethyl cellulose(CMC) and modified CMC.

The pharmaceutical composition of the present invention is preferablysterile and non-pyrogenic at the time of delivery, and is preferablystable under the conditions of manufacture and storage.

The compound of the present invention may be used in combination, eitheras separate units or fixed combinations with one or more of thefollowing: an antibody which binds to an unwanted inflammatory moleculeor cytokine such as interleukin-6, interleukin-8, granulocyte macrophagecolony stimulating factor, and tumor necrosis factor-α; an enzymeinhibitor such as a protease inhibitor aprotinin or a cyclooxygenaseinhibitor; an antibiotic such as amoxicillin, rifampicin, erythromycin;an antiviral agent such as acyclovir; a steroidal anti-inflammatory suchas a glucocorticoid; a non-steroidal anti-inflammatory such as aspirin,ibuprofen, or acetaminophen; or a non-inflammatory cytokine such asinterleukin-4 or interleukin-10. Other cytokines and growth factors suchas interferon-β, tumor necrosis factors, antiangiogenic factors,erythropoietins, thrombopoietins, interleukins, maturation factors,chemotactic protein, and their variants and derivatives that retainsimilar physiological activities may also be used as an additionalingredient.

The compound of the present invention may also be used in combinationwith drugs commonly used to treat lipid disorders in diabetic patients.Such drugs include, but are not limited to, HMG-CoA reductaseinhibitors, nicotinic acid, ezetimide, bile acid sequestrants fibricacid derivatives, MTP inhibitor, ACAT inhibitor and CETP inhibitors.Examples of HMG-CoA reductase inhibitors are lovastatin, pravastatin,simvastatin, rosuvastatin, fluvastatin and atorvastatin. Examples bileacid sequestrants are cholestyramine, colestipol and colesevelam.Examples of fibric acid derivatives are: gemfibrozil and fenofibrate,

Peptidomimetics of the invention may also be used in combination withanti-hypertensive drugs, such as, for example, diuretics, β-blockers,cathepsin S inhibitors, methyldopa, α2-adrenergic agonists, guanadrel,reserpine, β-adrenergic receptor antagonists, α1-adrenergic receptorantagonists, hydralazine, minoxidil, calcium channel antagonists, ACEinhibitors and angiotensin II-receptor antagonists. Examples ofβ-blockers are acebutolol, bisoprolol, esmolol, propanolol, atenolol,labetalol, carvedilol, and metoprolol. Examples of ACE inhibitors arecaptopril, enalapril, lisinopril, benazepril, fosinopril, ramipril,quinapril, perindopril, trandolapril, and moexipril.

Peptidomimetics of the invention may also be used in combination withcardiovascular drugs such as calcium channel antagonists, β-adrenergicreceptor antagonists and agonists, aldosterone antagonists, ACEinhibitors, angiotensin II receptor antagonists, nitrovasodilators, andcardiac glycosides.

Peptidomimetics of the invention may also be used in combination withanti-inflammatory drugs such as H1-receptor antagonists, H2-receptormediated agonists and antagonists; COX-2 inhibitors, NSAID, salicylates,acetaminophen, propionic acid derivatives, enolic cids, diarylsubstituted fuanones, cyclooxygenase inhibitors, and bradykinin agonistsand antagonists.

Method of Treatment

One aspect of the present invention provides for methods to treat asubject showing the symptoms of or at risk of developing atherosclerosisby administering one or more peptidomimetic of the present invention tothe subject in a therapeutically effective amount.

In general, an embodiment of the invention is to administer a suitabledose (e.g., daily dose) of a therapeutic composition that will be thelowest effective dose to produce a therapeutic effect, for example,mitigating symptoms, but consistently provide therapeutically effectivein vivo levels. The therapeutic peptidomimetics are preferablyadministered at a dose per subject per day of at least about 2 mg, atleast about 5 mg, at least about 10 mg, or at least about 20 mg asappropriate minimal starting dosages. In one embodiment of the methodsdescribed herein, a dose of about 0.01 to about 500 mg/kg can beadministered. In general, the effective dosage of the compound of thepresent invention is about 50 to about 400 micrograms of the compoundper kilogram of the subject per day. However, it is understood by oneskilled in the art that the dose of the composition of the inventionwill vary depending on the subject and upon the particular route ofadministration used. It is routine in the art to adjust the dosage tosuit the individual subjects. Additionally, the effective amount may bebased upon, among other things, the size of the compound, thebiodegradability of the compound, the bioactivity of the compound andthe bioavailability of the compound. If the compound does not degradequickly, is bioavailable and highly active, a smaller amount will berequired to be effective and/or less frequent dosing may be suitable(e.g., fewer times per day, less than once per day). The actual dosagesuitable for a subject can easily be determined as a routine practice byone skilled in the art, for example a physician or a veterinarian givena general starting point.

The compound may be delivered hourly, daily, weekly, monthly, yearly(e.g., in a time release form) or as a one-time delivery. The deliverymay be continuous delivery for a period of time, e.g., intravenousdelivery. In one embodiment of the methods described herein, the agentis administered at least once per day. In one embodiment, the agent isadministered daily. In one embodiment, the agent is administered everyother day. In one embodiment, the agent is administered every 6 to 8days. In one embodiment, the agent is administered weekly.

In one embodiment of the methods described herein, the route ofadministration can be oral, intraperitoneal, transdermal, subcutaneous,by intravenous or intramuscular injection, by inhalation, topical,intralesional, infusion; liposome-mediated delivery; topical,intrathecal, gingival pocket, rectal, intrabronchial, nasal,transmucosal, intestinal, ocular or otic delivery, or any other methodsknown in the art as one skilled in the art may easily perceive. Otherembodiments of the compositions of the invention incorporate particulateforms protective coatings, protease inhibitors or permeation enhancersfor various routes of administration, including parenteral, pulmonary,nasal and oral.

An embodiment of the method of present invention is to administer thepeptidomimetic of the present invention in a sustained release form.Such method comprises applying a sustained-release transdermal patch orimplanting a sustained-release capsule or a coated implantable medicaldevice so that a therapeutically effective dose of the peptidomimetic ofthe present invention is continuously delivered to a subject of such amethod. The compounds and/or agents of the subject invention may bedelivered via a capsule which allows sustained-release of the agent orthe peptide over a period of time. Controlled or sustained-releasecompositions include formulation in lipophilic depots (e.g., fattyacids, waxes, oils). Also contemplated by the invention are particulatecompositions coated with polymers (e.g., poloxamers or poloxamines).

In another related embodiment, the methods further compriseadministering at least one additional therapeutic agent. Such an agentmay be an antibody, an enzyme inhibitor, an antibacterial agent, anantiviral agent, a steroid, a nonsteroidal anti-inflammatory agent, anantimetabolite, a cytokine, or a soluble cytokine receptor. The enzymeinhibitor may be a protease inhibitor or a cyclooxygenase inhibitor. Theadditional agent may be added as a part of the pharmaceuticalcomposition, or may be administered concomitantly or within a timeperiod when the physiological effect of the additional agent overlapswith the physiological effect of the compound of the present invention.More specifically, an additional agent may be administered concomitantlyor one week, several days, 24 hours, 8 hours, or immediately before theadministration of the copolymer. Alternatively, an additional agent maybe administered one week, several days, 24 hours, 8 hours, orimmediately after the administration of the copolymer.

Another embodiment of the present invention is a method forprophylactically treating a subject at risk of developing an autoimmunedisease by administering a compound of the present invention. A subjectat risk is identified, for example, based on familial history, or anygenetic markers that correlate with atherosclerosis. Such prophylactictreatment may additionally comprise other pharmaceutical agents.

Research Tools

The peptidomimetics of the invention are also useful as research tools.For example, the peptidomimetics of the invention can be used toevaluate the anti-atherosclerotic potential of other compounds(including other peptidomimetics).

In addition, peptidomimetics of the invention can be used forinvestigating lipoprotein-receptor interactions in animals and animalmodels, particularly when a peptidomimetic is labeled (e.g., radioactivelabel, fluorescent label).

The peptidomimetics of the invention can also be used to identifyappropriate animal models for elucidation of lipid metabolic pathways.For example, the peptidomimetics can be used to identify animal modelswhere lipid peroxidation contributes to the progression ofatherosclerosis.

IV. Examples Example 1 Synthesis and Purification of a Retro-inversoPeptidomimetic Rev-D4F

The retro-inverso peptidomimetic Rev-D4F was synthesized using astandard peptide synthesis method and purified by high performanceliquid chromatography.

To assess the ability of purified Rev-D4F to interact withphospholipids, the purified peptidomimetic was mixed with1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC), which is a componentof membrane lipid bi-layer with which cholesterol is associated, andfractionated by gel filtration chromatography. Rev-D4F, similarly to L4Fand D4F, associated spontaneously with DMPC efficiently, and all of thepeptidomimetic co-eluted with the phospholipid (FIGS. 2B-D). Incontrast, only certain portions of intact Apo A-I protein associateswith the phospholipid spontaneously (FIG. 2A).

Example 2 Effect of Rev-D4F on SR-BI-dependent Cholesterol Efflux

The effect of Rev-D4F on the cholesterol efflux in a receptor-manner wasexamined. Scavenger receptor class B type I (“SR-BI”) is a receptor forHDL normally expressed on the surface of the liver cells. Tritiatedcholesterol was added to cells transfected with SR-BI, with wild typeApo A-I, L4F peptide, D4F peptide, or Rev-D4F peptidomimetic, and thepercentage of cholesterol efflux was determined.

When compared to Apo A-I on a per weight basis, L4F, D4F, and Rev-D4Fall were more efficient in promoting efflux than Apo A-I protein. Whencompared on per mole basis, all mimetic peptides were less efficientthan Apo A-I protein (see FIGS. 3A and B.

Example 3 Effect of Rev-D4F on ABCA1-dependent Cholesterol Efflux

The effect of Rev-D4F on the cholesterol efflux in a manner dependent onATP-binding cassette protein A1 (“ABCA1”) was also examined using thesame methodology as for SR-BI, except that ABCA1 was transfected.Similarly to SR-BI-dependent cholesterol efflux, L4F, D4F, and Rev-D4Fall were more efficient in promoting cholesterol efflux than Apo A-I onper weight basis. Also similarly to SR-BI-dependent efflux, all threewere less efficient than Apo A-I when compared on per mole basis (seeFIGS. 4A and B).

Example 4 Effect of Peptidomimetics on Plasma Lipid Oxidation

The present study measured the ability of Rev-D4F, D-4F, and L-4Fmimetic peptides to inhibit lipid peroxidation caused by human aorticendothelial cells and copper(II) sulfate, based upon inhibiting anincrease in concentrations of thiobarbituric acid-reactive substances(TBARS). As shown in FIGS. 5 and 6, all three mimetics significantlydecreased the amount of lipid peroxidation in the presence of anoxidant. Moreover, the inhibition in lipid peroxidation associated withRev-D4F was significantly greater than the inhibition associated withD-4F.

Example 5 Effect of Peptidomimetics on MCP-1 mRNA Expression

This study analyzed the effects of Rev-D4F, D-4F, and L-4F mimeticpeptides to reduce the levels of an anti-inflammatory marker, monocytechemotactic protein-1 (MCP-1). Based upon levels of MCP-1 mRNA, allthree peptidomimetics reduced the amount of MCP-1.

Example 6 Effect of Rev-D4F on ApoE-Null Mice

In this study, the comparative effect of Rev-D4F, D-4F, and L-4F mimeticpeptides on atherosclerosis in apoE-null mice was measured. Four groupsof apoE-null mice (4 weeks old, n=15) were fed a chow diet, andadministered water (control), Rev-D4F, D-4F, or L-4F mimetic peptides(1.6 mg/day, n=12/group) orally in drinking water for 6 weeks.Quantitative morphometry of aortic root cross sections stained withoil-red O was performed with NIH software.

Apo-AI mimetic peptides did not affect plasma total cholesterol,HDL-cholesterol, and non-HDL-cholesterol levels. L-4F had no effect onatherosclerotic lesions. Both Rev-D4F and D4F significantly (p<0.02)decreased lesion area by 46% and 33% respectively as compared to watercontrol. The data indicate that Rev-D4F is at least as effective or moreeffective than D-4F in preventing atherosclerosis at early stages oflesion formation in apoE-null mice.

Equivalents

Contemplated equivalents of the peptidomimetics, subunits thereof andother compositions described above include such materials whichotherwise correspond thereto, and which have the same general propertiesthereof (e.g., biocompatible), wherein one or more simple variations ofsubstituents are made which do not adversely affect the efficacy of suchmolecule to achieve its intended purpose. In general, the compounds ofthe present invention may be prepared by the methods illustrated in thegeneral reaction schemes as, for example, described below, or bymodifications thereof, using readily available starting materials,reagents and conventional synthesis procedures. In these reactions, itis also possible to make use of variants that are themselves known, butare not mentioned here.

All of the above-cited references are hereby incorporated by referencein their entireties.

I claim:
 1. A peptidomimetic with at least 90% identity to the D-amino acid sequence F-A-E-K-F-K-E-A-V-K-D-Y-F-A-K-F-W-D (SEQ ID NO:3).
 2. The peptidomimetic of claim 1, wherein the peptidomimetic improves lipid parameters in a subject.
 3. A peptidomimetic with at least 90% identity to the D-amino acid sequence Ac-F-A-E-K-F-K-E-A-V-K-D-Y-F-A-K-F-W-D-NH2 (SEQ ID NO:2), wherein the peptidomimetic comprises an N-terminal acetyl group or a C-terminal amide group.
 4. The peptidomimetic of claim 1, wherein the peptidomimetic further comprises a protecting group coupled to the amino or carboxy terminus of the peptidomimetic.
 5. A pharmaceutical composition, comprising a therapeutically effective amount of the peptidomimetic of claim 1 or
 3. 6. The composition of claim 5, wherein the composition is a sustained-release formulation.
 7. The composition of claim 5, further comprising a second active agent.
 8. A method for treating elevated levels of cholesterol in a mammal, comprising administering to said mammal a therapeutically effective amount of the composition of claim
 5. 9. A method for prophylactically treating a subject at risk of developing elevated levels of plasma cholesterol, comprising administering to the subject a pharmaceutically effective amount of the composition of claim
 5. 10. A method for treating a mammal showing symptoms of atherosclerosis, comprising administering to said mammal a therapeutically effective amount of the composition of claim
 5. 11. A method for prophylactically treating a subject at risk of developing atherosclerosis, comprising administering to the subject a therapeutically effective amount of the composition of claim
 5. 12. A method for improving the lipid parameters in a subject in need thereof, comprising administering to the subject a therapeutically effective amount of the composition of claim
 5. 13. The method of claim 12, further comprising administering a second active agent.
 14. A method of treating a patient suffering from a disease or condition that is treatable by altering lipid parameters, comprising administering to the subject a therapeutically effective amount of the composition of claim
 5. 15. A kit comprising the peptidomimetic of claim 1 or 3 in a pharmaceutically acceptable carrier, further comprising instructions for administration of the peptidomimetic for improving lipid parameters. 